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Emergency Coronary Artery Bypass Surgery Following Failed Balloon Angioplasty: Role of the Internal Mammary Artery Graft
Author(s) -
ZAPOLANSKI ALEX,
ROSENBLUM JOSEPH,
MYLER RICHARD K.,
SHAW RICHARD E.,
STERTZER SIMON H.,
MILLHOUSE FELIX G.,
ZATZKIS MARK,
WULFF CHRISTOPHER,
SCHECHTMANN NORBERTO S.,
SIEGEL SHARON,
BRONSTEIN MERRILL,
ELLERTSON DAVID,
LEARY LAUREL
Publication year - 1991
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.1991.tb00343.x
Subject(s) - medicine , culprit , cardiogenic shock , perioperative , cardiology , myocardial infarction , angioplasty , artery , right coronary artery , ejection fraction , coronary artery bypass surgery , circumflex , surgery , bypass surgery , heart failure , coronary angiography
A bstract During a 4‐year period (1986–1989), 3,502 patients had percutaneous transluminal coronary angioplasty (PTCA) in our institution. One hundred nineteen (3.4%) patients required emergency coronary artery bypass graft surgery (CABG) because of abrupt vessel closure following PTCA. Factors associated with vessel closure included lesion angulation ± 90° (p < 0.007), the presence of thrombus (p < 0.02), or a long (± 2 cm) lesion (p < 0.03). Of these 119 emergency CABG patients, 108 (91%) arrived in the operating room in a stable condition (group I) and 11 (9%) were in cardiogenic shock (group II). Five (45%) of the group II patients were admitted to the hospital with an acute myocardial infarction and all 11 patients had a higher incidence of multivessel disease (p < 0.05) and lower left ventricular ejection fraction (p < 0.001) than group I patients. The overall surgical mortality was 10.1%; however, in group I the mortality was 5.6% and in group II it was 54.5% (p < 0.001). The vessel that abruptly closed (“culprit vessel”) was the left anterior descending (LAD) in 60%, the right coronary artery in 27%, and the left circumflex in 13%. The internal mammary artery was utilized to bypass the culprit artery in 51 (43%) patients, including 50% of the culprit LADs. With group I culprit LAD patients, when the left IMA was the bypass conduit, there were no hospital deaths nor strokes and there was a 6.3% incidence of perioperative infarction.